A bone marrow transplant recipient develops aspergillosis. Which action should infection preventionists take to prevent additional cases?

• A. Review all recent and ongoing construction barriers.
• B. Isolate the patient with airborne precautions.
• C. Administer universal antifungal prophylaxis to all unit patients.
• D. Conduct routine environmental air sampling of the entire hospital.

Answer: (A)

The key idea is that aspergillosis in immunocompromised patients is often acquired from environmental Aspergillus spores that can be released during construction or renovation. The best way to prevent additional cases is to identify and control the environmental sources of dust and spores in or near patient care areas.

Reviewing all recent and ongoing construction barriers targets the source of exposure. It ensures proper containment of dust, sealing of work zones, dust suppression, and appropriate barriers between construction activities and high-risk patient areas. This kind of environmental control directly reduces inhalation exposure for vulnerable patients.

Isolating the patient with airborne precautions isn’t the most effective preventive step here because aspergillosis isn’t typically spread from person to person. Universal antifungal prophylaxis across the unit isn’t routinely recommended—it can lead to unnecessary drug exposure and resistance, and it doesn’t address the environmental source. Routine environmental air sampling of the entire hospital isn’t a practical or proven preventive approach for a hospital-wide risk; it doesn’t reliably prevent exposure in real time.

Focusing on construction controls and environmental barriers directly targets the root cause of many aspergillosis cases in a transplant unit, making it the best approach.